JOANNE FARYON: Hello, I'm Joanne Faryon.
Welcome to tonight's special, When Immunity Fails:
The Whooping Cough Epidemic.
We'll explore the worst whooping cough outbreak in California
in more than 60 years.
Just why is a disease that was nearly extinct thirty years ago,
finding its way back not just in this state, but in other parts
of the country as well?
What we learned may surprise you.
There are serious questions about how well the vaccine
to prevent the disease works;
questions government health officials have been slow
to even ask.
KPBS teamed up with the Watchdog Institute,
an investigative journalism center
at San Diego State University,
and Radio Netherlands Worldwide to tell this story.
A story that took us across California
and overseas to Amsterdam.
But first, we begin in a delivery room
in a San Diego hospital, where a mother has just given birth
to her third son.
[ baby crying ]
Matthew Jacob Bryce was born Oct 11, 2010.
A healthy baby boy, the third boy for Cindy and Marlon Bryce.
Matthew started showing signs of a cold
when he was just two weeks old.
The Bryce family knew something was wrong.
MARLON BRYCE: So it just seemed
like this cold it was just affecting his breathing.
FARYON: The family was aware of the whooping cough epidemic
in California, from news reports REPORTER:
State health officials say more than 6,400 cases
of whooping cough have been reported this year.
FARYON: And their pediatrician.
BRYCE: There wasn't any whooping
or they always say there is a whooping or a cough,
he didn't have a cough or anything it was just
that there was a cold.
FARYON: Matthew's doctor suspected it could be whooping
cough, also known as pertussis.
She took a nasal swab and sent it to the lab.
She also started Matthew on antibiotics.
Six days later, with Matthew just 23 days old,
Cindy Bryce got a phone call
from the California Department of Health.
The diagnosis was whooping cough.
M. BRYCE: The moment I heard it I just immediately started
thinking the worst because you have heard the news
about the babies that have passed away.
FARYON: From January to October this year,
10 newborns in California died from whooping cough,
two in San Diego County.
More than 7,000 children and adults got sick
from the disease - the highest number in the state
in more than 60 years.
Just how did Matthew and so many others come down with a disease
that is supposed to be preventable with a vaccine?
Tonight we'll raise questions
about the effectiveness of that vaccine.
A four-month investigation by KPBS and the Watchdog Institute,
found many people who have been diagnosed
with whooping cough were immunized.
We also show how government data on the number
of people diagnosed with whooping cough lacks timeliness
and is often inconsistent, begging the question:
just who is keeping track of this epidemic?
We'll show you how some of the experts
who influence vaccine policy are financially tied
to vaccine companies.
And, we'll follow the Bryce family as they struggle
with their son's diagnosis, and the setbacks in his recovery.
Whooping cough, violent cough, the hundred-day cough;
all names for pertussis.
DR. JAMES CHERRY: What causes the cough actually we
don't know...
there's no other cough quite like it.
FARYON: Pertussis is a respiratory illness caused
by the bacterium bordetella pertussis.
At first, it can mimic a cold.
But later produces a violent and persistent cough,
a cough that leaves children gasping for air -
creating the distinct whooping sound.
For adults, whooping cough may only be a nuisance.
In fact scientists estimate more than 80 percent
of adult cases are never diagnosed
because most people assume they just have a bad cold.
But to infants whooping cough can be deadly,
especially if not diagnosed early.
DR. JAMES CHERRY: So with infection
that you eventually clear the bacteria and you get better.
But it's a prolonged, a good percentage
of cases will last one or two months.
DR. FRITS MOOI: After a pertussis infection it has been
shown to get super infections, in fact that is one
of the main complications, pneumonia.
FARYON: Young babies aren't able to cough up secretions
that collect in their lungs, leading to pneumonia
and making it difficult to breathe.
Early antibiotic treatment is most critical in this age group.
Whooping cough was nearly wiped out by the late 1970's
because of mass immunization,
but it's somehow found its way back to California
and other highly vaccinated communities around the world.
Just why it's made such a vengeful comeback has two
of the world's leading whooping cough experts in disagreement.
Dr. James Cherry of UCLA: CHERRY:
The main reason is increased awareness.
FARYON: and Dr. Frits Mooi of the Netherlands Centre
for Infectious Diseases Control.
MOOI: We found really a new mutation in the bug.
FARYON: Dr. Mooi and Dr. Cherry both began their research
into Whooping Cough about 30 years ago.
Cherry in the U.S. and Mooi in The Netherlands.
The two scientists know each other's work.
CHERRY: First of all, his molecular microbiological is,
he's right at the top of scholars.
There's no question about that.
I think where some of the things he's published is the clinical
data are not very good.
MOOI: I don't communicate too much with him but what he wrote
in the press is that I screw up epidemiology.
That doesn't help me too much.
FARYON: To understand why these two experts disagree,
you need to know a little about the history
of the pertussis vaccine.
ANNOUNCER: Since most serious cases occur before school age,
immunization in school may be too late.
FARYON: The bacteria that causes whooping cough was first
isolated in Belgium in 1906.
At the time, the illness was one
of the leading causes of infant death.
ANNOUNCER: In 1921, whooping cough killed 316
Michigan children.
Last year, the number of deaths was reduced to 63.
FARYON: The discovery lead to the first attempts at a vaccine.
But it wasn't until the late 1940's scientists developed a
vaccine effective enough to prevent whooping cough.
ANNOUNCER: Unlike the disease however,
a vaccine does not endanger life.
FARYON: By 1946, mass immunization programs began
in the U.S. and the number of cases dropped dramatically.
Prior to the vaccine the rate
of disease was 157 cases per 100,000.
By the 1970's, with large scale immunizations, fewer than one
in one hundred thousand people got whooping cough.
But the vaccine was not without controversy.
The early versions were associated with side effects
such as prolonged crying spells and seizures in babies.
By 1996, the FDA approved a new whooping cough vaccine.
It was called an acellular version.
That means the vaccine uses only purified components
of the disease-causing organism.
That vaccine was considered to be safer and associated
with few mild side effects.
Today, the U.S. uses only the acellular pertussis vaccine.
But as the United States was changing vaccines something else
was happening - health officials
across the country were reporting increasing numbers
of positive whooping cough cases.
And in a government lab about 30 minutes outside of Amsterdam,
a group of scientists had discovered something else -
the bacterium that causes whooping cough started
to look a little different.
MOOI: This new mutation had the effect that the bacteria started
to produce more pertussis toxin.
FARYON: Just whether that mutation is to blame,
at least in part, for the California epidemic
and outbreaks elsewhere in the world is at the heart
of the whooping cough debate.
Dr. Mooi believes this to be the case, but not Dr. Cherry.
CHERRY: Even though these changes have occurred there is
no evidence that that's lead to increased vaccine failure.
FARYON: Here in San Diego County, more than 85 percent
of children are immunized.
In fact, less than three percent
of kids entering kindergarten have not been immunized
because of their family's personal beliefs.
But despite the high immunization rate,
San Diego has the second largest number
of positive whooping cough cases in California.
Dr. Dean Sidelinger is San Diego's deputy public
health officer.
DR. DEAN SIDELINGER: This is a disease
that if someone has it it's very easy to transfer
from one person to another.
So if you or I sitting here during this interview,
one of us had pertussis chances are we could transmit
that to the other person.
Sidelinger says in the past,
the number of whooping cough cases peaked in summer
and slowed by fall, but this year, that didn't happen.
SIDELINGER: So as time goes on we're seeing more cases.
We know that public awareness plays into that as we talk
about pertussis more people are asking their doctors
and doctors are asking their patients we're going
to see more, but that trend continued.
FARYON: By the end of November 2010, nearly 1000 infants,
children and adults in San Diego County tested positive
for whooping cough.
More than half of them had been immunized.
Our investigation shows
that trend continues throughout California.
KPBS and The Watchdog Institute collected data
from 9 California counties that report some
of the highest infection rates.
Our research shows that where immunization history is known,
between 44 and 83 percent of people diagnosed
with whooping cough were vaccinated.
We looked at California Department
of Public Health records too.
In cases where vaccination history was recorded,
more than 80 percent of infected people had been immunized.
DR. MARK HORTON: From the epidemiology experts
and the experts in vaccine that this is absolutely expected.
FARYON: Dr. Mark Horton is the director
of the California Department of Public Health.
HORTON: If you've got a percentage
of the population vaccinated and a percentage of those vaccinated
that are still susceptible
because the vaccine isn't perfectly effective or effective
in all individuals, when you work
out the arithmetic you'll see that even
with a very effective vaccine,
and even if you have the majority
of the population vaccinated,
the pool of susceptibles will include a number of individuals
that have never been vaccinated
but will also include quite a few and in some cases greater
than 50 percent
of the individuals have been previously vaccinated.
FARYON: In other words, if you do the math,
you will always find a certain number
of immunized people getting sick
if a vaccine is not 100 percent effective.
HORTON: So that's no surprise to us nor is it a reflection
on the efficacy of the vaccine.
REPORTER KEVIN CROWE: It's not a reflection
on the efficacy of the vaccine?
HORTON: Correct, correct.
FARYON: But 20 years ago, the reverse was true.
According to a report by the Centers for Disease Control,
more than half of the children between 3 months and 4 years old
who got whooping cough nationwide between 1990
and 1996 were not immunized.
The rate of whooping cough has also been increasing
for the past 20 years.
From less than one in 100,000
to 18 per 100,000 here in California.
And in some California counties such as San Luis Obispo,
rates are nearly as high as before vaccines were developed.
Two days after our interview
with the Bryce family, Matthew got a fever.
He was hospitalized at Rady's Children's Hospital
in San Diego.
Matthew was not immunized against whooping cough.
He's too young.
Babies can't be immunized until they're two months old.
But everyone else in the Bryce family was vaccinated -
even his parents got booster shots.
The practice of immunizing everyone
around a newborn baby is called cocooning.
CINDY BRYCE: When I called the doctor they asked me who has it
and I couldn't give them an answer because I don't know
where he got it from because everyone's been vaccinated.
FARYON: Myron and one of his sons were also tested
for whooping cough - both were negative.
M. BRYCE: The one thing I would want
to know is the vaccine working?
Is it as effective because before this I thought the
vaccine was working and I thought that if I did everything
that I was told to do that our sons would be protected.
FARYON: Just how effective is the vaccine?
That all depends on who you talk to.
Drug information included
with the two most commonly used whooping cough vaccines
in the US say the vaccine is 85 percent effective.
MOOI: This new strain has completely invaded the
Netherlands and also other countries and pushed
out all the other strains.
It's quite unique.
FARYON: Dr. Mooi believes there's no way
to determine how effective the vaccines are
because they have not been tested
against the new strain of whooping cough.
MOOI: We call it the p3 strain.
FARYON: A strain he believes is more virulent
and can make people sicker.
This strain emerged while the new acellular vaccines were
being developed.
MOOI: I can tell you one
of the reasons the vaccine companies is not too happy
with me is because if what I say is true they selected the wrong
strains the in the 1980's.
FARYON: Mooi's lab was studying the new strain
when The Netherlands experienced an unexpected whooping cough
epidemic in 1996.
MOOI: There were more strains in fact
when you compare the two there was a very direct relationship
between the emergence of these strains, we call them p3 strains
and the increase in pertussis notifications.
CHERRY: There's absolutely no evidence that either
of the two vaccines that are most common today used
in the U.S. that there is increased vaccine failure
with either of those vaccines.
FARYON: So if you had to explain why we're seeing this epidemic
the highest number of cases in 60 years,
what would you tell people?
CHERRY: The main reason is increased awareness.
People, particularly public health people are much more
aware and that trickles down.
FARYON: Cherry says the increase is also due in part
because of something called waning immunity.
Immunity to whooping cough does not last a lifetime,
whether you are vaccinated or develop natural immunity
from getting the disease.
Almost all experts agree waning immunity is contributing
to whooping cough outbreaks worldwide.
Where they disagree: when does immunity fail?
Dr. Mooi believes the new strain of pertussis causes immunity
to fail sooner than in the past.
And he's published his findings
in several peer reviewed journals including the CDC's
Infectious Diseases.
MOOI: When the immunity is sub-optimal what will happen the
bacteria will not be recognized very well by the immune system
because of the mismatch and second of all even
if immune response is started
in the body the toxin will be able to delay it.
You could say these two changes work together
by decreasing the period
of which the vaccine is protective further.
FARYON: The Netherlands learned something else
after its 1996 epidemic.
At the time, it had very few samples of the bacteria
that was causing people to get sick.
So Mooi's lab began asking doctors and their labs
to send him positive pertussis swabs.
His lab now has 3,000 samples.
California that has collected just 29 samples from the more
than 7,000 whooping cough cases in the state.
During the KPBS/Watchdog four month investigation,
we also learned data kept by the state
and the CDC was often lagging behind county data
and was inconsistent.
While counties like San Diego knew the immunization status
of the vast majority of people with whooping cough,
the state's data listed the information as unknown.
Despite statewide protocols for reporting pertussis,
a KPBS/Watchdog survey found some counties don't follow them
or are slow to report the information HORTON:
There's a perception that the more numbers the better,
but let me be very clear we in no way need reports
on every single case of pertussis for us
to make important judgments and decisions
about what's happening.
FARYON: The CDC in Atlanta declined our requests
for an interview.
In an email response they said it is "difficult
to disentangle all the factors" contributing to increases
in pertussis, but listed "increasing transmission,
better recognition,
and increased laboratory confirmation."
We also asked whether a new more virulent strain could be
contributing to the outbreak.
The CDC's response: "Available data do not suggest
that ptxP3 is more virulent,
or that increasing reports are attributable only
to the emergence of ptxP3.
We continue to work on this and other potential explanations
for the increase in pertussis
that has occurred since the 1980s."
The CDC sent us this study by their own investigators.
The study looked at children
between 6 months and five years old.
It found pertussis vaccines to be more
than 90 percent effective.
The study looked at data between 1998 and 2001.
It did not collect pertussis strain information.
SINGING: Do you happen to know what a T-dap is?
It's a special vaccine but it's not just for kids.
FARYON: Sanofi Pastuer, one of two companies
that make the vaccine widely used in the U.S.,
sponsored this singing competition earlier this year.
SINGING: Persussis is the reason why you should call your
doctor today.
FARYON: It was a public relations exercise
to get the word out about whooping cough and immunization.
But just where is the line between good PR and trying
to influence public health policy?
SINGING: Take a shot and give pertussis a whooping.
FARYON: Especially when public health policy can increase
vaccine sales.
Since 2007, the California department
of health has spent more than $200 million
on pertussis vaccines for children on medical
or who are under-insured.
And it's sure to rise.
In September, the California state legislature passed a law
requiring all students to receive another does,
a sixth dose of the pertussis vaccine before entering
middle school.
It may be a case of what's good
for business is also good for public health.
But how much influence does industry have
over public health policy?
Sanofi Pasteur also established
and funds The Global Pertussis Initiative.
A group made up of medical experts from around the world.
The GPI was established 10 years ago
to study why pertussis was making a comeback and find ways
to control the disease.
More than half its members are employees
of the pharmaceutical company
or receive research money or consulting fees.
Public officials from across the country, including California
and the CDC, site the Global Pertussis Initiative
when making vaccine policy.
Dr. James Cherry is a member of the initiative.
He's also received speaking fees and research funds
from vaccine manufacturers.
At the same time, he sat on government committees
to help determine vaccine policy and efficacy.
FARYON: A cynic might say that if you have a community
of experts in pertussis as in the Global Pertussis Initiative,
who primarily their work in terms
of this endeavor is being funded by the drug company
that makes the vaccine, there might be less incentive
to say make a new vaccine and more incentive
to say just use the old one more often.
What do you say to them?
CHERRY: I don't think that's true.
I think that we've been talking about new vaccines.
It think the difficulty with the new vaccine lies in the expense
that it would cost to make a new vaccine and the difficulty
in testing it and FDA requirements for it and I think
if the climate was right for two
of the major manufacturers they would do it.
MOOI: And these are three different pertussis strains.
FARYON: Dr. Mooi is a critic of the Pertussis Initiative.
MOOI: My big disappointment is they have totally
and I think willfully ignored pathogen adaptation.
I think a few years ago we had the year
that Darwin died 100 year ago, it was not so long ago,
I think it's very strange that evolution
and pathogen adaptation is completely ignored
by such a group.
I find that bad for science and bad for public health.
FARYON: Sanofi Pastuer released this statement to KPBS
and the Watchdog Institute.
It says its grant to the GPI brings the world's authorities
on pertussis together and that benefits society as a whole.
The company also says "at the present time,
there is no evidence to suggest current pertussis vaccines
lack effectiveness."
Dr. Dean Sidelinger was one of the first health officials
to learn immunized people were getting sick in his county.
He said he was surprised, but in the end,
he says the current vaccine is still the best thing he's got
to protect his community.
SIDELINGER: It does significantly decrease the
pertussis we see a significantly lower number
of pertussis cases now then we saw before we started using
the vaccine.
So we don't want people to feel complacent to say I don't want
that vaccine because I've seen many of the cases
that have been reported were fully vaccinated.
FARYON: Sidelinger says there would be many more cases
if there was no vaccine at all.
Dr. Mooi agrees.
He believes public health officials should be encouraging
cocooning, immunizing all those around newborn babies.
But in the long run, he says we need better vaccines.
Baby Matthew spent four days in the hospital
and was eventually discharged.
Today, he's getting his two-month routine check-up.
DOCTOR: I think it was just back luck he's had two illnesses
in a row and now the cold he's building up his immunity.
FARYON: Despite a stuffy nose, Matthew is doing well today.
DCOTOR: As you might know the vaccine is not
as effective as we want it to be.
And that's one reason why there've been a lot of cases.
But with Matthew in particular, his own immunity has kicked
in from having the illness, that is, in effect a sort
of a booster that will protect him going forward.
And how long that immunity lasts is still a question.
MARLON: The one thing I would want to say
to parents is just watch your kids, just be concerned.
Because at first we thought we were being over protective.
But I'm glad we were just a little bit over-concerned.
FARYON: Since KPBS and the Watchdog Institute began its
investigation, state health officials, the CDC
and scientists from UCLA, including Dr. James Cherry,
began a new study to determine whether the new strain
of pertussis is contributing
to the current whooping cough outbreak.
For more on this story, and to see more of the data collected
in our investigation, go to kpbs.org/whoopingcough
and watchdoginstitute.org.
For KPBS, the Watchdog Institute
and Radio Netherlands Worldwide, I'm Joanne Faryon.
Thanks for watching.